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Urban Adolescent Females' Views on the Implant and Contraceptive Decision-Making: A Double Paradox

1997; Guttmacher Institute; Volume: 29; Issue: 4 Linguagem: Inglês

10.2307/2953380

2325-5617

Heather Kuiper, Suellen Miller, Elena María Jaimes Martinez, Lisa Loeb, Philip D. Darney,

Male Reproductive Health Studies

Focus groups and in-depth interviews were used to explore the decline in popularity of the contraceptive implant in a clinic-based sample of 41 ethnically diverse, urban, sexually active adolescents. While these teenagers' socioeconomic status and patterns of inconsistent contraceptive use made them potentially ideal implant recipients, they were unlikely to select this method. Negative media reports about the method were less influential than social conditions such as peer perspectives and gender relations. Oral networks that propagated misinformation went unchallenged because of the silence of satisfied users. Personal factors such as future orientation, autonomous decision-making and value of control also influenced contraceptive decision-making.As increasing numbers of clinical and postmarketing trials confirmed the high efficacy and acceptability of contraceptive implants, use of this method declined precipitously in the US. This paradox was investigated in focus groups and in-depth interviews involving 35 low-income adolescent clients 14-20 years of age and 6 counselors at the San Francisco (California, US) General Hospital Teen Family Planning Clinic. The mean age of clients was 17.3 years; 46% were Hispanic, 40% were Black, and 9% were Asian. 71% of these teens were very concerned about avoiding pregnancy, making them potentially ideal implant acceptors. Regardless of whether they had ever used the implants, adolescents shared positive views about the method's convenience and long-lasting effects and deep concerns regarding its visibility and the side effects of hormonal contraception. To these teens, contraceptive selection resembled fashion fads, with considerable attention to social trends. Deterrents to implant selection included negative peer perceptions, a fear of stigmatization associated with having a visible sign of sexually activity, male partners' negative attitudes toward pregnancy prevention, and community suspicion that the implants were a form of population control aimed at poor, minority women. The oral interpersonal network that constituted the main source of information about the implants was marked by an absence of testimony from satisfied users. In terms of personal attributes, a strong future orientation and the capacity for autonomous decision making supported implant selection, while concerns about control over one's body and fear of pain discouraged method use. These findings indicate a need for reproductive health programs to be more responsive to the social, physical, cognitive, and developmental concerns teenagers face in contraceptive selection.